Provider Demographics
NPI:1124058466
Name:MACCONNELL, LINDA S (PA-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:MACCONNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:PEITZMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2075 S COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3040
Mailing Address - Country:US
Mailing Address - Phone:480-718-0568
Mailing Address - Fax:480-999-4102
Practice Address - Street 1:2075 S COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3040
Practice Address - Country:US
Practice Address - Phone:480-718-0568
Practice Address - Fax:480-999-4102
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2509363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2509OtherSTATE PA LICENSE